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目的探讨含/不含全身照射(TBI)作为预处理方案在自体外周血干细胞移植(APBSCT)治疗自身免疫性疾病中的造血重建、免疫重建、疗效和并发症等方面的差异。方法自1999—2006年6月,共有32例严重的自身免疫性疾病患者接受了 APBSCT。其中女性27例、男性5例,中位年龄29岁(15～49岁)。所有患者均采用环磷酰胺(CTX)+粒细胞集落刺激因子(rhG-CSF)方案动员,采集物均应用 CliniMACS 细胞分选仪分选 CD34~+细胞。21例患者预处理方案采用CTX+TBI,11例采用 CTX+抗胸腺细胞球蛋白(ATG)。结果两组的造血重建 CTX+TBI 组粒细胞植入中位时间为11 d,CTX+ATG 组为9 d,组间比较差异有统计学意义(P=0.003),两组血小板植入的中位时间分别为13 d 和8 d,组间比较,P=0.001;移植后12个月时两组患者淋巴细胞各亚群均已恢复,但 CD4/CD8比值仍倒置,各亚群水平两组间差异均无统计学意义;所有患者随访12个月以上,CTX+TBI 组有3例(14.3%)复发,CTX+ATG 组有2例(18.2%)复发,其余患者病情稳定;移植期间 CTX+TBI 组细菌感染发生率为5/21(23.8%),病毒感染1例(4.8%),放射性腮腺炎4/21(19%),CTX+ATG 组细菌感染发生率为2/11(18.2%),病毒感染2例(18.2%),血清病反应3/12(25%)。两组患者感染均在抗生素或抗病毒治疗后很快得到控制,均无因血小板减少引起致命的出血并发症。两组患者在随访时间内均未出现肺间质纤维化、白内障等远期并发症。结论含 TBI 的预处理方案在造血重建上迟于不含 TBI 的方案,但 CTX+TBI 的耐受性好,疗效上两者无明显差异,在免疫重建方面差别不明显。
Objective To investigate the differences of hematopoietic reconstitution, immune reconstitution, curative effect and complications in the treatment of autoimmune diseases by autologous peripheral blood stem cell transplantation (APBSCT) with / without whole body irradiation (TBI) as a preconditioning regimen. Methods From 1999 to June 2006, a total of 32 patients with severe autoimmune disease underwent APBSCT. There were 27 females and 5 males, with a median age of 29 years (15-49 years). All patients were mobilized by CTX + rhG-CSF. Clinique cells were sorted by CliniMACS cell sorting CD34 ~ + cells. Twenty-one patients underwent CTX + TBI for pretreatment and CTX + anti-thymocyte globulin (ATG) for 11 patients. Results The median time for granulocyte implantation was 11 days in CTX + TBI group and 9 days in CTX + ATG group. There was significant difference between the two groups (P = 0.003) Bit time were 13 d and 8 d, respectively, between groups, P = 0.001; at 12 months after transplantation, the lymphocyte subsets of both groups recovered, but the ratio of CD4 / CD8 was still upside down, with two subgroups All patients were followed up for more than 12 months. Three patients (14.3%) in CTX + TBI group relapsed, and two patients (18.2%) in CTX + ATG group relapsed. The rest patients were stable. CTX The incidence of bacterial infection was 5/21 (23.8%) in TBI group, 1 case (4.8%) in viral infection, 4/21 (19%) in mumps and 2/11 (18.2 cases in CTX + ATG group %), 2 cases of virus infection (18.2%) and 3/12 (25%) of serum sickness. Infection in both groups was quickly controlled after antibiotic or antiviral treatment, with no fatal bleeding complications due to thrombocytopenia. No long-term complications such as interstitial fibrosis and cataract occurred in both groups during the follow-up period. CONCLUSION: The TBI-containing preconditioning regimen is later than the non-TBI-containing regimen in hematopoietic reconstitution. However, CTX + TBI is well tolerated and has no significant difference in curative effect. The difference in immune reconstitution is insignificant.